A Wake-Up Call about Relapse

Cory Monteith, Glee actor, was found dead in his hotel room in Vancouver recently from a heroin and alcohol overdose. He was frank about his long history of struggles with addiction beginning as a teenager, using “anything and everything” by the time he was 16. Most recently, he checked himself into rehab just this past March.

As a doctor who treats opiate addiction every day in my office in San Francisco, I see many accomplished people like Cory who are working hard to get and stay clean.

Unlike the myth of addicts being complete train wrecks — barefoot and disheveled — my patients are high-functioning. They are lawyers, computer programmers, housewives, construction workers and entrepreneurs. They work, raise families and contribute to their communities.

I help each of them plan for relapse because the likelihood is so high and the risks are so deadly. After a period of being clean, the body’s tolerance for opiates lowers and doses previously used become deadly.

Sadly, it’s not entirely surprising that Cory’s overdose came after a recent rehab.

Brain chemistry has a lot to do with why relapse is so common. Opiates have an intense effect on the brain. They are engineered to make you feel really good and they do this so well that within a short time of using, it becomes very difficult to feel “normal” without the drug. Even after months or years of being clean people struggle with withdrawal symptoms of depression, anxiety and insomnia.

When the going gets tough, people in recovery need something other than opiates to help them through. Preparation is the key to prevention.

In my practice, I combine medications with mind/body training. There are several FDA-approved medications, like buprenorphine, that can help people get off the roller coaster of opiate addiction. Within a few days of taking the medication, cravings are gone for the vast majority of people.

Buprenorphin, isn’t a cure-all, but it does save lives. It helps the brain to start healing and creates some breathing room for people to learn healthier ways to manage the ups and downs of life.

Relapse is virtually a given unless patients learn skills to reduce anxiety and sleep better, get nutrients that best support brain, body and recovery and develop tools for dealing with cravings, withdrawal and pain.

The brain can heal. It’s not easy, but I’ve found when people understand how opiates work in their brains, they are better able to take their recovery in new directions.

By Alex Zaphiris, MDFrom: http://psychcentral.com/blog/archives/2013/07/20/cory-monteith-a-wake-up-call-about-relapse/

Birthdays

I have been thinking about my birthday, which is in a few weeks. I will be turning 35. My husband mentioned that he and the kids would like to take me out to dinner for my birthday. I said I wasn't sure because it seems like we only fight now when we spend time together and I didn't want to spend my birthday fighting.

I was thinking back to his 37th birthday, the year after he relapsed. We were separated but had decided to go to dinner as a family.

During dinner, my son asked in his little 5-year-old voice, Daddy, why are you an alcoholic?

There was a long awkward pause. My husband's face looked crushed. I can't remember what we said but I remember it did not seem adequate.

I remember my husband later telling me that he cried on the way home.

I thought of all this and felt extremely sad. I don't know if he chose to relapse. I tend to think that because I can't understand taking a drink after years of sobriety. In that moment at least, I know that he felt remorse, which is something I rarely see from him.

I think the hardest thing for me to accept in all of this is that my husband has rarely appeared to be sorry for his actions. And his actions have caused all of us a lot of pain.

People make mistakes. I accept that. But patterns are hard to accept.

I am sad that addiction has taken over his family. I have often thought that he was pretty much destined to be an addict in that family. I also had always hoped things would get better with him. But wishing does not make it so.

Hating Myself

I had another mostly sleepless night last night. I am back to listening to a lot of my New Age tapes - Louise Hay right now. I started doing some affirmations and meditations to help me sleep. I realized last night how hard it has become - my mind wanders almost immediately.

I think I have really begun to hate myself. I thought I just hated what my life (for the most part) has become and the actions of my husband and his family. But it became apparent last night that that has transferred to me too.

I think it's hard for me to forgive now because I did all this when my husband went to rehab the first time. I wasn't sure I should continue on in the relationship. But I decided it was better for my son and I worked on myself while he was at rehab for 2 months.

I felt at that time, that all was forgiven. We had a few good years together in there. I did not bring up the past. We had our daughter, which was a very joyous time for me.

But then, he relapsed - and now I almost feel foolish for not believing that he would. It seems now it would have been easier to leave that wall up and move on at the time of the first rehab.

But now I am two kids in and many more years. I don't know where this relationship will end up. But I don't want to keep feeling this way.

Unsent Letter #3 - Spring 2009

J,

The way you treat people, and especially the way you treat me and J - and even our son on occasion has never been OK with me - and I'm beginning to see that it never will be any different.

I am unwilling and unable to have any sort of a relationship with you.

The thing that continues to stick out in my mind is what J's counselor has said - that even without the examples of mistreating J I gave her, the way you have treated both J and I continually over the years are NOT GOOD INDICATORS OF HOW YOU WILL TREAT OUR CHILDREN IN THE FUTURE.

It seems important to you to keep us in the gutters. And after a lifetime of treating J this way, you may be able to keep him there.

But you will never keep me there, and you will never keep my children there.

You like to comment on what you think our socio-economic position is. And I think my grandma had a great response. "J. is poor. Poor in spirit." I'd have to say I agree.

Whatever your beef is with J or his work ethic or his relapses, the truth of the matter is that you are at the root of all of that. You are the most unkind person I have ever met in my life - you and your wife and your family that steals from each other and fights over money. It makes me sick. All of you make me sick. There is nothing about you that I would want for my children. Nothing.

You have nothing to offer. All you have done is caused pain. It is painful to even be around you. It is painful to live in the aftermath of what you have created. It is painful to know that my children even bear a part of you.

And I want nothing further to do with you.

The Marriage Counselor

I went to a marriage counselor today with my husband and it was awful. He was very direct and I didn't like him very much.

Seemed like my husband was giving him a real song and dance about our life together and I was just getting more and more angry and interjecting at all the false spots.

He asked if I was willing to try and asked why I hadn't filed for divorce. I said because I feel totally stuck financially like I don't even have a choice. Our finances are completely fucked.

So my husband started saying that wasn’t all his fault and I disagreed because he was the one who stopped working for a year and that's when this all started.

So he said something about me not working and I barged right in and said NO! I have been working and you never acknowledge that taking care of kids is work too even if you don't get paid for it.

We went round and circles around him not coming home all night and to the birthday party. He gave explanations for both, but I said there is just no explanation that will ever be good enough for me. I just don't understand. And the counselor said, No, you just don't like it.

And I said, that too but I just can't understand or comprehend his behavior.

I told the Counselor that I didn't grow up with a father this way and I was not used to living this way or being around drugs.

My husband said, that's not true!! Your step dad is an alcoholic and your mom had drugs in the house!

And I said, No, my mom had some marajuana and that's not the same thing. And my dad always came home for dinner and never stayed out all night long. And even my step dad never acted like you have. And I have never been called a BITCH, or had cocaine in my home right where my daughter could access it.

My husband told us that his dad had told him not to come to the birthday party and that he had also been talking to a lot of other people about it. He said that everyone had told him that all my friends and family would be at the party and if he couldn’t contain himself he shouldn’t go. He said his dad had more than 20 years of sobriety and that he had been divorced and was on his fourth marriage so he knew a lot about these things. He was insinuating that it was some sort of a set-up for him to lose it in front of a bunch of people I reminded him that I had invited all his friends too. Of course, none of them came.

I said that his dad was the most dysfunctional person I have ever met so I don’t understand why he would ever got to him for any sort of advice.

The Counselor asked when the last time both of us had felt good about our marriage. My husband said it was when he got back from Betty Ford. I responded that it was when our daughter was a baby, right before he relapsed.

Then I broke down. I said if I had ever known he was ever going to relapse again - even if there was a slight chance - I never would have married him. It's just too hard for me. I can’t live like that.

Towards the end he asked if I was even willing to try and I said that I don't feel any hope. The only way I can do it is if we remain separated. I can't live with him now and put my kids (and me) through him not coming home again.

So my husband said he wanted more time with the kids then and I said I wasn't willing to let him drive anywhere with him. I told them I wasn't willing to take any sort of risk with my kid’s lives. I carried those kids in my stomach for 9 months and I have been the one taking care of them 24-7 and I am not going to let anyone take them away from me. Even if the risk is .000000008%, I won't do it. And if he demands that I will get a lawyer and fight it.

So my husband backed down. And said he would stick to the original agreement in good faith while we are separated.

The Counselor said that all the research shows that kids do best when parents raise their kids together - even when they are divorced. And I said I realize that and I have talked to our son’s counselor about it and read the Sandcastles book (about helping kids get through a divorce) but with my husband’s drug and alcohol addictions I still need to protect my kids. And he said he understood that and all advice was the ideal and that he knew we had special circumstances.

He asked if we were willing to date or spend time with each other during the separation. I told him we had done some of that but for the most part I needed my space. I explained that when my husband stayed too long at the house I tired of him and wanted him to leave. This seemed to really piss off my husband. I said the only way we can build back trust is for him to actually do the things he says he will over time with me and the kids and in meeting our financial obligations. If he didn’t do that, nothing would work.

So my husbands tone got nasty and he said, Fine! You can just stay separated and do whatever you want to do and wear your ring on the other finger or take it off altogether.

And then I started laughing and said yeah but your tone is totally pissed off and you don't sound like you mean that at all.

The Counselor did tell my husband at the end that he got bad advice about not going to the party.

I’m not sure if we will go back or not. My husband left very angry and I said I wasn’t sure that we could resolve anything. He told us to call him if we want to set up another appointment.

My husband just sent me a text saying, thanks for going and being honest. At least I know where we stand.

The Relapse

Shortly after our second wedding anniversary, my husband and I were invited to an extended weekend at the Four Seasons outside of San Diego. My husband was already there, after several days on business in LA.

I left our kids at home with my mother and flew down to meet him. It should have been a clue to me that he sent a driver instead of picking me up himself. He was golfing. While it annoyed me, I didn't want it to ruin our time together, and I put it on the back burner.

We stayed at a 2-bedroom suite as guests of our friend Trevor* from Beverly Hills. It was a high-end timeshare of some sort that Trevor’s parents own. Trevor wears makeup and takes bubble baths. He annoys me, but he’s completely lovable in his own way.

My husband is a recovering alcoholic. He's been in recovery now for three years but his mother just died and our friend killed himself and then my grandpa got sick right after that. After caring for my Pappa for 6 weeks in his home, he died too. I'm not so sure my husband is sober anymore, but whenever I ask him he says he is. He swears he is.

The first part of the trip isn't so bad. We eat well, sit by the pool, actually have sex (a small miracle with two young children). But then more people join us. We sit and talk on our balcony alone for a while. My husband seems giddy. Is he drunk? I never seem to be able to catch him drinking. He doesn’t slur his words, but there have been times when he does not come home, and other times when he is very mean. My husband is not a mean person.

We talk about our life, and our plans. Things seem hopeful. He seems happy. He says he wants to do things different. He has been working a lot. I barely see him lately. I am glad to hear these words, but I am hesitant. Is he drunk? Is this too good to be true?

After a nice Italian dinner, and many, many drinks, the bill comes and none of our affluent friends seem to have any money. After hours of hearing all the details of their personal wealth, my husband is left with another large tab. We roll eyeballs at each other as he hands over the American Express card.

I confront Trevor about the drinking while my husband takes over the piano bar, singing some Sinatra song. Trevor says he may have had a few beers earlier. I am agitated, but decide to wait until we are alone to speak to him. On the ride home, he becomes belligerent. By the time we reach the hotel, we are openly fighting. The couple who is driving us tries to intervene, but it is useless.

And this is where it gets hazy. I'm not sure what is real, what is remembered, what is embellished, what has been blocked, and when I went completely insane. I asked my husband about whether he is drinking again and this time he admits it. He goes to a bottle of tequila in the kitchen and nearly guzzles the whole thing. I am hysterical. I beat his chest, or maybe it is the wall, or the bed or the pillow. Do I end up on top of him? We are screaming.

Trevor comes in and begs us to stop. He says he is traumatized. He says everyone can hear us and this is his parents place and he will hear about it in the morning. Trevor takes his Ambien and drinks some more. I am crying and not making any sense. My husband leaves the room for something and I lock him out. I start calling people, basically anyone, hysterical, and drunk myself. The AA people must think I’m completely nuts. I cry all night. I wonder what will become of our life. I don't know how I could have been so stupid. I am angry for believing a lie that was so obvious. I wanted to believe it. A relapse was so inconvenient for me.

At some point I unlock the door and let my husband back in. We are both still angry. I am unable to come out of bed the entire next day. I can not come to terms with my life. I decide to tell my husband that I will not leave him if he gets sober. As if he could just stop right then, and it would all be over, and we could go back to our neat little life.

Trevor knocks on the door to settle the bill early in the morning. I wouldn't look at him or him at me. My head hurts and I want to die, literally. He doesn't have any money, but he won’t say this in front of me, so my husband has to go into the other room with him. When we leave, we see one of the other couples from dinner, the people who drove us home. We mutually ignore each other. The plane ride home is silent.

I wish I could say that it was one day that determined the course of my life forever and everything got better from there. But life is never that obvious. It was a hangover of that night, a relapse that went on for more than a year before my husband finally went to treatment. But it was the residue from that day that caused me to see my own sickness, my own part in things.
A good marriage is not handed to you. A good life does not happen by itself (usually). But somehow I lived most of my life waiting for someone else to make everything right for me and got mad when that didn't happen. That day was a kick in the head, a slap in the face, telling me to wake up.

Addiction runs on both sides of our families and I was no place to be complacent with two small children. I had to deal with my own co-dependency issues. I had to finally look at what had brought me to marry an addict after growing up around them on my moms side of the family.
I do not know why that day took a year to manifest. It was the worst year of my life. I found cocaine in my home and separated from my husband. I refused my own birthday party. I stopped talking to my father-in-law. A friend died from complications of ALS and then my husband’s stepbrother killed himself. I wore a size zero that year, and I felt like a zero, a nothing. My son had 9 cavities and had to go under to have them fixed. I didn’t feel like such a great mother anymore.

At the end of an emotional session with my counselor, she sensed that I was near the end of my rope. She stopped me. "What are you proud of?" I could think of nothing. Tears came when she told me, "You could have fallen apart. You didn’t." She reminded me of all the things that I had held together that year and that I should be proud of.

I had resisted AA and Al-Anon because I hated the concept that I was not in control of alcoholism. But in truth, we are in control of nothing.

Perhaps growing up with addicts had prohibited me from being able to see things as they are. I never learned to trust my own reality. I never knew I was even entitled to one. I needed a year of harsh realities because that one day did not wake me up from my self-inflicted coma.

But on that day I vowed I would never drink that much again (and I have not). I would always speak my truth (and I have). And, that I would stay with my husband.

I wasn’t always sure about that last part. I think the year also was necessary to determine whether I wanted to be married. I had to decide whether the relationship was worth salvaging and what lengths I was willing to go to in fulfilling my vows.

Most of the advice I received was not positive. But I always remembered the last sentences of a very heartfelt email my father wrote to me later that day. “Give him all of your love. You have all of my support.” Somehow those words carried me through.

At the time, I felt like the relapse was somehow a betrayal of our love. I now realize that my husband has a terminal disease and we both need to work our own programs.

At our wedding, my father had performed Billy Joel’s “I love you Just the Way You Are.” I watched the video with my children when my husband went into rehab, hoping for some inspiration. My dad’s voice cracked in some places, the range was a little high for him. It was part of the beauty of the song. My being able to appreciate him singing it, and him being willing to do it, knowing it would not be his best. Both of us are complete and total perfectionists. I had chosen that song. It wasn’t, “I Love You Just the Way I Want You to Be.”

I spent a lot of time reading. I spent a lot of time reflecting. I spent a lot of time fighting, learning how to defend myself. For a long time, I had put up with too much. I had been silent. I wanted things to go smoothly, but silence never willed them that way.

My husband is now in recovery and so am I. All that day, I wanted to put my head under the covers and disappear, but life with children does not give you that luxury. I had to go home. I am grateful I did not have the option to tune out, for the slap in the face that made me realize that this was my life waiting for me to wake up and be present.